Independence Plus Initiative
Persons with disabilities.
Severe disabilities: Yes.
Statewide after pilot in two sites (including one Indian Nation).
- The purpose of the grant is to expand consumer-directed service delivery options, increase consumer control, and establish effective consumer protections through the establishment of a cash and counseling option for State plan self-directed personal assistance services (PAS) and the home and community-based services (HCBS) program for elderly and disabled.
- The State will enhance consumer protections by implementing an emergency backup system, a disaster and emergency plan, increasing the availability of caregiver background checks, and improving its incident management plan.
- The State plans to implement all five phases or aspects of Independence Plus as outlined by the Centers for Medicare & Medicaid Services (CMS).
Goals, Objectives, and Activities
Goal: Plan for development of cash and counseling model.
- Research best practices.
- Conduct community information forums.
- Establish oversight committee.
- Conduct forums on reservations and invite members of Tribes into the oversight committee.
- Complete and submit 1115 waiver application.
- Prepare 1915(c) Amendment.
- Conduct statewide focus groups and compile information from the groups.
- Administer consumer survey regarding grant goals and objectives and compile data for oversight committee.
- Develop selection criteria for cash and counseling participant.
Goal: Develop person-centered planning components of cash and counseling model.
- Develop person-centered planning assessment form that is culturally sensitive and has alternate formats.
- Produce consumer education and training materials.
Goal: Develop individual budgeting component of cash and counseling model.
- Determine process for individual cash allowance.
- Determine audit process.
- Develop method of compiling information to be available for public review.
Goal: Develop financial management service component of cash and counseling model.
- Solicit potential providers.
- Establish financial management as a Medicaid reimbursable service.
- Develop protocol for service.
- Enroll providers at pilot sites.
- Train providers.
- Apply for Robert Wood Johnson (RWJ) grant to implement debit card if recommended.
Goal: Develop support brokerage process component of cash and counseling model.
- Establish support brokerage as a Medicaid reimbursable service.
- Solicit potential provider participation and enroll providers.
- Develop communication plan for consumer, bookkeeper, and broker.
- Train providers.
Goal: Develop participant protection component of cash and counseling model.
- Establish emergency backup system.
- Enhance Job Service employer/employee job registry website.
- Develop a plan to facilitate caregiver background checks.
- Develop incident management protocol.
- Enhance partnership with Ombudsman program, including applying for RWJ grant to link Ombudsman with cash and counseling program.
Goal: Implement cash and counseling pilot program and evaluate the pilot.
- Enroll participants into the pilot program.
- Conduct workshop with pilot participants.
- Finalize and disseminate education materials (manuals and brochures).
- Implement pilot.
- Evaluate pilot via satisfaction survey, in-person interviews, and group interviews.
Key Activities and Products
- Research best practices into cash and counseling models and conduct forums (also on reservations) and focus groups, and administer consumer surveys to inform the research.
- Complete and submit 1115 waiver application and prepare a 1915(c) amendment to facilitate cash and counseling program.
- Develop selection criteria for cash and counseling participant.
- Determine process and audit process for individual cash allowance, and develop method of compiling information on cash allowances to be available for public review.
- Establish financial management and support brokerage as a Medicaid reimbursable service, and solicit, enroll, and train potential providers.
- Develop communication plan for consumer, bookkeeper, and broker under the support brokerage component of the cash and counseling program.
- Establish participant protection component to include emergency backup system and incident management protocol.
- Enhance Job Service employer/employee job registry website, and develop a plan to facilitate caregiver background checks.
- Conduct and evaluate a pilot of the cash and counseling program in three sites, including an Indian nation.
Consumer Partners and their Involvement in Implementation Activities
- Persons with disabilities or long-term illness will be involved in all aspects of program design, implementation, and evaluation through participation on the oversight committee, focus groups, task forces, and the website administrator group.
- The State will set aside scholarship funds to allow maximum attendance by consumers, family members, and caregivers at the annual Montana Community Services Bureau Conference. The State will also add a website to keep the public informed of the grant's progress and allow for the influx of comments and suggestions to the project coordinator.
Public and Private Partners and their Involvement in Implementation Activities
- The Native American Coordinator at the Montana Center on Disabilities, Montana State University, will spearhead outreach to Indian Nations and ensure cultural sensitivity in all phases of program development and implementation.
- Department of Labor will partner in the development of a caregiver registry via their existing Job Service web page.
- Department of Justice will assist in the implementation of caregiver background checks.
- Disaster and Emergency Services Division will collaborate on the establishment of the emergency backup system.
- Summit Independent Living Center will produce participant training materials and train participants.
- Mountain Pacific Quality Health Foundation, Montana's Quality Improvement Organization, will collaborate in the development and implementation of the capacity assessment protocol.
- The Department will use Montana's Statewide Independent Living Council, the Governor's Advisory Council on Aging, Special Education Advisory Council, and the Governor's Advisory Council on Disabilities, as sounding boards throughout the grant period.
Advisory Body, Committee, or Task Force
- A grant oversight committee will direct the project, provide managerial oversight, and chair the oversight committee. The grant coordinator will be responsible for daily management of the project. The oversight committee will meet on a quarterly basis to discuss progress of all phases and the problems encountered, and will make any necessary decisions about changes to the timeline.
- Several working committees will report to the oversight committee and implement the five components of the cash and counseling program.
- The committee will comprise consumers, community provider agencies, legislators, advocacy agencies, and others interested in the long term care system.
Formative/Process Evaluation Activities
- Each phase will report to a working committee and the oversight committee. These working committees and the grant coordinator will be responsible for setting detailed timelines and reporting mechanisms. These subject matter experts will be the individuals who must lead and support the project contractor through the difficulties and problem solving that will occur. They will evaluate the progress of the grant activities to ensure that timelines, tasks, and objectives are met and milestones achieved.
- To gather in-put during the first 2 years, focus groups will meet at least every 6 months, 4 weeks before the oversight committee meets. Staff will submit reports to Montana's Statewide Independent Living Council, the Governors Advisory Council on Disabilities, the Special Education Advisory Council, and the Governor's Advisory Council on Aging to gather comments throughout the life of the grant. State staff will present the oversight committee with progress reports, comments from the councils, and input from focus groups regarding grant activities.
- In addition, State staff will present all phases of the project each year of the grant at the annual Community Services Bureau Conference, the Governor's Conference on Aging, the Developmental Disabilities Conference, the Brain Injury Conference and others as requested.
- State staff will evaluate the pilot program through a satisfaction survey, in-person interviews, and group interviews.
Summative/Outcome Evaluation Activities
At the conclusion of the grant period, an outcome evaluation and a recommendation report will be completed.
Strategies to Ensure Sustainability
- Meeting the grant goals will give consumers quality services in a manner consistent with their community living preferences and priorities while enhancing consumer protections.
- Cash and counseling will become a permanent option to individuals enrolled in the HCBS and PAS programs. This sustainability will be accomplished by State administrative rule and, if necessary after further legal opinions, by a change in State statute in the 2005 legislative session.